• 1. 北京大學藥學院,藥事管理和臨床藥學系,北京,1000832. 北京大學第三臨床醫(yī)學院藥劑科,北京,100083;

目的 　通過對左室結構參數(shù)、血液動力學參數(shù)、心功能級別改善及副作用發(fā)生率等指標進行比較,探討血管緊張素轉化酶抑制劑(angiotensin-converting enzyme inhibitor,ACEI)與血管緊張素受體阻滯劑(angiotensin receptor blocker,ARB)治療充血性心力衰竭是否具有相似的療效和安全性.
方法 　計算機檢索MEDLINE(1966～2004)、EMBASE(1989～2000)、Cochrane圖書館臨床對照試驗資料庫(2004年第1期)、國際藥學文摘(IPA)(1970～2004)、中國生物醫(yī)學文獻光盤數(shù)據(jù)庫(1980～2003),納入比較ACEI和ARB治療充血性心力衰竭患者的隨機對照試驗,對納入研究的方法學質量進行評價,并應用RevMan 4.2軟件進行統(tǒng)計分析.
結果 　共納入17個隨機對照試驗.Meta分析結果表明,ACEI與ARB對于左室舒張末期內(nèi)徑、心輸出量、心率、心功能級別改善等方面的作用差異無統(tǒng)計學意義(P＞0.05),ACEI與ARB治療中產(chǎn)生副作用例數(shù)的合并效應量差異有統(tǒng)計學意義[RR 2.17,95%CI (1.53,3.07),P＜0.000 01].
結論 　ACEI與ARB兩類藥物對心功能和左室重構方面的作用差異無統(tǒng)計學意義;在藥物安全性方面,ACEI較ARB副作用發(fā)生率更高,安全性更低,其差異有統(tǒng)計學意義.在充血性心力衰竭的治療中,ARB可適用于對ACEI不能耐受的病例,上述結論對于臨床用藥具有很好的指導意義.

引用本文： 吳 浩,翟所迪. 血管緊張素轉化酶抑制劑與血管緊張素受體阻滯劑治療充血性心力衰竭的系統(tǒng)評價. 中國循證醫(yī)學雜志, 2005, 05(3): 196-205. doi: 復制

1. 葛德元, 趙一舉. 心力衰竭的藥物治療[M]. 第2版. 北京: 科學技術文獻出版社, 2000. p. 27.
2. 劉少巖, 貢軍麗. 厄貝沙坦與卡托普利治療慢性充血性心力衰竭的療效觀察[J]. 吉林醫(yī)學, 2001; 22(6): 332～333.
3. 孫小豐, 陳麗清, 韓國紅, 李勇, 林佩娣, 程梅芬. 蘆沙坦對老年慢性心力衰竭的血液動力學效應[J]. 中國臨床藥學雜志, 2000; 9(1): 4～6.
4. 張傳煥, 沈玉芳, 陳大年, 鄭慧, 沈言喜. 氯沙坦對充血性心力衰竭患者左室質量指數(shù)的影響[J]. 安徽醫(yī)科大學學報, 2000; 35(2): 133～135.
5. 王邦寧, 張傳煥, 沈玉芳, 劉敏, 陳大年, 高丹屏. 氯沙坦對充血性心衰患者心功能及循環(huán)NO/ET的影響[J]. 中國臨床藥理學與治療學, 2001; 6(1): 56～58.
6. 王圣, 孫翠芳, 李新明, 劉宇飛, 丁彥春, 曲鵬. 氯沙坦與苯那普利治療老年慢性心功能不全的研究[J]. 海南醫(yī)學, 2002; 13(9): 5～7.
7. 張傳煥, 沈玉芳. 氯沙坦治療充血性心力衰竭23例[J]. 醫(yī)藥導報, 1999; 18(6): 404～406.
8. 李修昌, 谷惠敏. 氯沙坦治療老年充血性心力衰竭療效觀察[J]. 蘇州醫(yī)學院學報, 2001; 21(2): 168～170.
9. 蘇偉, 張華, 李偉章, 徐亞君. 氯沙坦治療心功能不全的臨床研究[J]. 陜西醫(yī)學雜志, 2001; 30(6): 336～337.
10. 吳隱雄, 唐建華, 韋永強, 趙毅蘭, 林英忠, 高鵬, 黃其昌. 培哚普利和氯沙坦對心肌梗死并心衰病人左室重構抑制作用的對比研究[J]. 廣西醫(yī)科大學學報, 2003; 20(3): 365～367.
11. 方衛(wèi)華, 劉志忠. 纈沙坦加苯那普利對慢性心力衰竭患者血流動力學的影響[J]. 南京部隊醫(yī)藥, 2002; 4(1): 10～12.
12. 李奕璉. 依貝沙坦與卡托普利治療老年性慢性充血性心力衰竭的觀察[J]. 實用醫(yī)學雜志, 2003; 19(2): 201～202.
13. 陳化, 劉秀梅, 王登科. 厄貝沙坦與培哚普利治療老年慢性心力衰竭療效的對比研究[J]. 中華老年多器官疾病雜志, 2002; 1(3): 197～199.
14. Ge DY, Zhao YJ. Drug therapy of heart failure[M]. 2nd ed. Beijing: Scientific and Technical documents Publishing House, 2000. p. 27.
15. Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: Is blinding necessary[J]? Control Clin Trials, 1996; 17(1): 1-12.
16. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in Meta-analyses[J]. Lancet, 1998; 352(9 128): 609-613.
17. Willenheimer R, Helmers C, Pantev E, Rydberg E, Lofdahl P, Gordon A; Heart Failure Valsartan Exercise Capacity Evaluation Study Group. Safety and efficacy of valsartan versus enalapril in heart failure patients[J]. Int J Cardiol, 2002; 85(2-3): 261-270.
18. Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO. Valsartan in heart failure patients previously untreated with an ACE inhibitor[J]. Int J Cardiol, 1998; 65(3): 239-246.
19. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, Deedwania PC, Ney DE, Snavely DB, Chang PI. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE)[J]. Lancet, 1997; 349(9 054): 747-752.
20. Brooksby P, Robinson PJ, Segal R, Klinger G, Pitt B, Cowley AJ. Effects of losartan and captopril on QT dispersion in elderly patients with heart failure. ELITE study group[J]. Lancet, 1999; 354(9 176): 395-396.
21. Liu SY, Gong JL. The clinical observed on the chronic congestive heart failure after Irbesartan and captopril treatment[J]. Jilin Medical Journal, 2001; 22(6): 332-333.
22. Sun XF, Chen LQ, Han GH, Li Y, Lin PD, Cheng MF. Effect of losartan on chronic congestive heart failure in senile patients[J]. Chinese Journal of Clinical Pharmacy, 2000; 9(1): 4-6.
23. Zhang CH, Shen YF, Chen DN, Zheng H, Shen YX. Effect of losartan on left ventricular mass index in patients with congestive heart failure[J]. Acta Universitatis Medicinalis of Anhui, 2000; 35(2): 133-135.
24. Wang BN, Zhang CH, Shen YF, Liu M, Chen DN, Gao DP. Effect of losartan on cardiac function and secretion of nitric oxide and endothelin in patients with congestive failure[J]. Chin J Clin Pharmacol Ther, 2001; 6(1): 56-58.
25. Wang S, Sun CF, Li XM, Liu YF, Ding YC, Qu P. Effects of losartan versus enalapril on the elder patients with chronic heart failure[J]. Hainan Medicine, 2002; 13(9): 5-7.
26. Zhang CH, Shen YF. 23 cases of patients of congestive heart failure after losartan treatment[J]. Herald of Medicine, 1999; 18(6): 404-406.
27. Li XC, Gu HM. The clinical observed on the elder patients with congestive heart failure after losartan treatment[J]. Acta Academiae Medicinae Suzhou, 2001; 21(2): 168-170.
28. Su W, Zhang H, Li WZ, Xu YJ. Effects of losartan on the patients with chronic heart failure[J]. Shanxi Medical Journal, 2001; 30(6): 336-337.
29. Wu YX, Tang JH, Wei YQ, Zhao YL, Lin YZ, Gao P, Huang QC. Comparison of losartan and perindopril in inhibition of left ventricular remodeling of patients with heart failure and myocardial infarction[J]. Acta of Guangxi Medical University, 2003; 20(3): 365-367.
30. Fang WH, Liu ZZ. The heamodynamic effects of valsartan combined with benazepril in patients with chronic heart failure[J]. Journal of Southeast China National Defence Medcial Science, 2002; 4(1): 10-12.
31. Li YL. The clinical observed on the elder patients with chronic congestive heart failure after irbesartan and captopril treatment[J]. The Journal of Practical Medicine, 2003; 19(2): 201-202.
32. Chen H, Liu XM, Wang DK. Efficacy and safety of irbesartan and perindopril in treatment of chronic heart failure in aged patients: a comparative study[J]. Chin J Mult Organ Dis Elderly, 2002; 1(3): 197-199.
33. Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, Konstam MA, Riegger G, Klinger GH, Neaton J, Sharma D, Thiyagarajan B. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial-the Losartan Heart Failure Survival Study ELITE Ⅱ[J]. Lancet, 2000; 355(9 215): 1 582-1 587.
34. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, Deedwania PC, Ney DE, Snavely DB, Chang PI. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE) [J]. Lancet, 1997; 349(9 054): 747-752.
35. Witte K, Thackray S, Banerjee T, Clark AL, Cleland JG. Update of ELITE-Ⅱ, BEST, CHAMP, and IMPRESS clinical trials in heart failure[J]. Eur J Heart Fail, 2000; 2(1): 107-112.
  1. 1. 葛德元, 趙一舉. 心力衰竭的藥物治療[M]. 第2版. 北京: 科學技術文獻出版社, 2000. p. 27.
  2. 2. 劉少巖, 貢軍麗. 厄貝沙坦與卡托普利治療慢性充血性心力衰竭的療效觀察[J]. 吉林醫(yī)學, 2001; 22(6): 332～333.
  3. 3. 孫小豐, 陳麗清, 韓國紅, 李勇, 林佩娣, 程梅芬. 蘆沙坦對老年慢性心力衰竭的血液動力學效應[J]. 中國臨床藥學雜志, 2000; 9(1): 4～6.
  4. 4. 張傳煥, 沈玉芳, 陳大年, 鄭慧, 沈言喜. 氯沙坦對充血性心力衰竭患者左室質量指數(shù)的影響[J]. 安徽醫(yī)科大學學報, 2000; 35(2): 133～135.
  5. 5. 王邦寧, 張傳煥, 沈玉芳, 劉敏, 陳大年, 高丹屏. 氯沙坦對充血性心衰患者心功能及循環(huán)NO/ET的影響[J]. 中國臨床藥理學與治療學, 2001; 6(1): 56～58.
  6. 6. 王圣, 孫翠芳, 李新明, 劉宇飛, 丁彥春, 曲鵬. 氯沙坦與苯那普利治療老年慢性心功能不全的研究[J]. 海南醫(yī)學, 2002; 13(9): 5～7.
  7. 7. 張傳煥, 沈玉芳. 氯沙坦治療充血性心力衰竭23例[J]. 醫(yī)藥導報, 1999; 18(6): 404～406.
  8. 8. 李修昌, 谷惠敏. 氯沙坦治療老年充血性心力衰竭療效觀察[J]. 蘇州醫(yī)學院學報, 2001; 21(2): 168～170.
  9. 9. 蘇偉, 張華, 李偉章, 徐亞君. 氯沙坦治療心功能不全的臨床研究[J]. 陜西醫(yī)學雜志, 2001; 30(6): 336～337.
  10. 10. 吳隱雄, 唐建華, 韋永強, 趙毅蘭, 林英忠, 高鵬, 黃其昌. 培哚普利和氯沙坦對心肌梗死并心衰病人左室重構抑制作用的對比研究[J]. 廣西醫(yī)科大學學報, 2003; 20(3): 365～367.
  11. 11. 方衛(wèi)華, 劉志忠. 纈沙坦加苯那普利對慢性心力衰竭患者血流動力學的影響[J]. 南京部隊醫(yī)藥, 2002; 4(1): 10～12.
  12. 12. 李奕璉. 依貝沙坦與卡托普利治療老年性慢性充血性心力衰竭的觀察[J]. 實用醫(yī)學雜志, 2003; 19(2): 201～202.
  13. 13. 陳化, 劉秀梅, 王登科. 厄貝沙坦與培哚普利治療老年慢性心力衰竭療效的對比研究[J]. 中華老年多器官疾病雜志, 2002; 1(3): 197～199.
  14. 14. Ge DY, Zhao YJ. Drug therapy of heart failure[M]. 2nd ed. Beijing: Scientific and Technical documents Publishing House, 2000. p. 27.
  15. 15. Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ. Assessing the quality of reports of randomized clinical trials: Is blinding necessary[J]? Control Clin Trials, 1996; 17(1): 1-12.
  16. 16. Moher D, Pham B, Jones A, Cook DJ, Jadad AR, Moher M, Tugwell P, Klassen TP. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in Meta-analyses[J]. Lancet, 1998; 352(9 128): 609-613.
  17. 17. Willenheimer R, Helmers C, Pantev E, Rydberg E, Lofdahl P, Gordon A; Heart Failure Valsartan Exercise Capacity Evaluation Study Group. Safety and efficacy of valsartan versus enalapril in heart failure patients[J]. Int J Cardiol, 2002; 85(2-3): 261-270.
  18. 18. Mazayev VP, Fomina IG, Kazakov EN, Sulimov VA, Zvereva TV, Lyusov VA, Orlov VA, Olbinskaya LI, Bolshakova TD, Sullivan J, Spormann DO. Valsartan in heart failure patients previously untreated with an ACE inhibitor[J]. Int J Cardiol, 1998; 65(3): 239-246.
  19. 19. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, Deedwania PC, Ney DE, Snavely DB, Chang PI. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE)[J]. Lancet, 1997; 349(9 054): 747-752.
  20. 20. Brooksby P, Robinson PJ, Segal R, Klinger G, Pitt B, Cowley AJ. Effects of losartan and captopril on QT dispersion in elderly patients with heart failure. ELITE study group[J]. Lancet, 1999; 354(9 176): 395-396.
  21. 21. Liu SY, Gong JL. The clinical observed on the chronic congestive heart failure after Irbesartan and captopril treatment[J]. Jilin Medical Journal, 2001; 22(6): 332-333.
  22. 22. Sun XF, Chen LQ, Han GH, Li Y, Lin PD, Cheng MF. Effect of losartan on chronic congestive heart failure in senile patients[J]. Chinese Journal of Clinical Pharmacy, 2000; 9(1): 4-6.
  23. 23. Zhang CH, Shen YF, Chen DN, Zheng H, Shen YX. Effect of losartan on left ventricular mass index in patients with congestive heart failure[J]. Acta Universitatis Medicinalis of Anhui, 2000; 35(2): 133-135.
  24. 24. Wang BN, Zhang CH, Shen YF, Liu M, Chen DN, Gao DP. Effect of losartan on cardiac function and secretion of nitric oxide and endothelin in patients with congestive failure[J]. Chin J Clin Pharmacol Ther, 2001; 6(1): 56-58.
  25. 25. Wang S, Sun CF, Li XM, Liu YF, Ding YC, Qu P. Effects of losartan versus enalapril on the elder patients with chronic heart failure[J]. Hainan Medicine, 2002; 13(9): 5-7.
  26. 26. Zhang CH, Shen YF. 23 cases of patients of congestive heart failure after losartan treatment[J]. Herald of Medicine, 1999; 18(6): 404-406.
  27. 27. Li XC, Gu HM. The clinical observed on the elder patients with congestive heart failure after losartan treatment[J]. Acta Academiae Medicinae Suzhou, 2001; 21(2): 168-170.
  28. 28. Su W, Zhang H, Li WZ, Xu YJ. Effects of losartan on the patients with chronic heart failure[J]. Shanxi Medical Journal, 2001; 30(6): 336-337.
  29. 29. Wu YX, Tang JH, Wei YQ, Zhao YL, Lin YZ, Gao P, Huang QC. Comparison of losartan and perindopril in inhibition of left ventricular remodeling of patients with heart failure and myocardial infarction[J]. Acta of Guangxi Medical University, 2003; 20(3): 365-367.
  30. 30. Fang WH, Liu ZZ. The heamodynamic effects of valsartan combined with benazepril in patients with chronic heart failure[J]. Journal of Southeast China National Defence Medcial Science, 2002; 4(1): 10-12.
  31. 31. Li YL. The clinical observed on the elder patients with chronic congestive heart failure after irbesartan and captopril treatment[J]. The Journal of Practical Medicine, 2003; 19(2): 201-202.
  32. 32. Chen H, Liu XM, Wang DK. Efficacy and safety of irbesartan and perindopril in treatment of chronic heart failure in aged patients: a comparative study[J]. Chin J Mult Organ Dis Elderly, 2002; 1(3): 197-199.
  33. 33. Pitt B, Poole-Wilson PA, Segal R, Martinez FA, Dickstein K, Camm AJ, Konstam MA, Riegger G, Klinger GH, Neaton J, Sharma D, Thiyagarajan B. Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial-the Losartan Heart Failure Survival Study ELITE Ⅱ[J]. Lancet, 2000; 355(9 215): 1 582-1 587.
  34. 34. Pitt B, Segal R, Martinez FA, Meurers G, Cowley AJ, Thomas I, Deedwania PC, Ney DE, Snavely DB, Chang PI. Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE) [J]. Lancet, 1997; 349(9 054): 747-752.
  35. 35. Witte K, Thackray S, Banerjee T, Clark AL, Cleland JG. Update of ELITE-Ⅱ, BEST, CHAMP, and IMPRESS clinical trials in heart failure[J]. Eur J Heart Fail, 2000; 2(1): 107-112.